What's Wrong With Fat? (22 page)

In 1999, the presses’ greater tendency to characterize obesity as an epidemic was largely due to its overwhelming focus on a study entitled “The Spread of the Obesity Epidemic in the United States, 1991–1998,” which was accompanied by an editorial commenting on this study and was discussed by more than half of the 1999 news sample. 30 This research report used the series of maps, discussed in chapter 2, showing the percentage of people in each state with a BMI of 30 or higher over time. The maps showed that, while only three states had less than 10 percent of the population with a BMI over 30 in 1991, no states had such low rates in 1998. While only three states had over 15 percent of the population with a BMI over 30 in 1991, the overwhelming majority of the states fell into this category in 1998, making it look as if obesity was spreading across states like an infection. 31 The way a front-page article in the
Milwaukee Journal Sentinel
quoted the authors of the study was typical: “Rarely do chronic conditions such as obesity spread with the speed and dispersion characteristics of a communicable disease epidemic.” 32

Figure 4.2:
Percentage of Scientific Studies or News Reports Dramatizing Obesity.

My analyses suggest that news articles reporting on “The Spread of the Obesity Epidemic in the United States, 1991–1998” are significantly more likely, compared to articles that do not discuss this study, to refer to obesity as an epidemic. 33 Specifically, among the 43 news articles that reported on “The Spread of the Obesity Epidemic,” 67 percent describe obesity as an “epidemic,” compared to 19 percent of news articles not discussing this study. A typical news report on the study quotes the then-director of the CDC Jeffrey Koplan saying that excess weight is increasing as rapidly as an infectious disease might spread and that it should be treated as seriously as an epidemic. 34

In both 1999 and 2003, the news sample is also more likely than the science sample to blur the lines between different weight categories. Typically, news articles take extreme examples in the context of a discussion about overweight or obesity. For instance, one article discussed a “285-pound” man and his “248-pound wife,” “a 100-pound 3-year-old girl,” “417-pound 15-year-old boy,” and children who “had to be weighed on a loading dock scale” in a discussion of “obesity,” even though these individuals would have each been in the heaviest 5 percent or less of the U.S. population. 35
After reviewing these extreme cases, the article noted that “59 percent of Wisconsin adults already are either overweight or obese,” 36 giving the impression that extreme cases are more representative than they are. Thirty-nine percent of the 1999 news sample, compared to 20 percent of the 1999 science sample, blur the lines between different weight categories. In 2003, these figures are 53 and 10 percent.

In 2003, disproportionate focus on the research report “Health Related Quality of Life of Severely Obese Children and Adolescents” largely explains the presses greater tendency to blur the lines between different weight categories. 37 Although the title of this research report refers to “severely obese” children and the abstract specifies that the average BMI of participants was 34.7, both the abstract and study often refer simply to “obese” children. The first line of the abstract presents the context as: “One in 7 US children and adolescents is obese, yet little is known about their health-related quality of life (QOL),” falsely implying that the research sample was representative of this larger group of youngsters. It reports the findings as:
“Compared with healthy children and adolescents, obese children and adolescents reported significantly (p<0.001) lower health-related QOL in all domains.... ” A full 94 percent of press articles discussing this particular study blur the lines between different weight categories, compared to 31 percent of news articles that do not discuss this research report. 38 A typical news headline about this study follows the lead of the researcher: “Obesity hurts kids’ lifestyles like cancer.” 39 A
USA Today
article quotes the lead author: “This study demonstrates how difficult it is to be an obese child.” 40

News media focusing on the most dramatic studies, however, is not the whole story. It does not account for the greater tendency of 1999 news articles, compared to the 1999
JAMA
theme issue, to blur the lines between different weight categories, nor the greater mention of an “obesity epidemic” by the 2003 news reports, compared to the 2003 theme issue.
And the news media’s selective attention does not explain why 46 percent of the 1999 news sample and 27 percent of 2003 news reporting used war metaphors, even though these metaphors are not in
any
of the original science articles. For instance, a 2003 news article quotes a diabetes specialist saying “[Obesity’s] a time bomb.” 41 These persistent differences may be due to greater journalistic pressures to create drama to sell copy.
Moreover, press releases seem to have facilitated the use of such metaphors. In both 1999 and 2003, the official
JAMA
press releases use war metaphors and, in 1999 only, refer to obesity as an epidemic. 42

THE NEWS MEDIA AND MORALITY TALES

In the previous chapter, we saw the ways in which news media reports overwhelmingly frame “obesity” as a question of personal responsibility, with only secondary attention given to sociocultural and biological factors.
Science contributes to this framing in so far as health and disease are typically studied at the level of the individual with solutions formulated at that level as well. Epidemiology, which studies the causes, distribution, and control of disease in populations, specifically tends to take the individual as the unit of analysis, thus favoring a focus on individual behavior as the cause and solution for illness. These tendencies, however, are further exaggerated by news reporting on science, which tends to be “people-centered,” in which “clearly identified individuals personify or stand in for larger, more difficult to grasp social forces,” and “news tends to simplify complex social processes in ways that emphasize melodrama, that turn a complex set of phenomenon into a morality tale.” 43

As is shown in figure 4.3, news reporting on each of the two theme issues of
JAMA
is more likely than the issues themselves to attribute obesity to factors under people’s individual control, including choosing to be sedentary or making bad food choices. In contrast, news reports are not consistently more likely to discuss sociocultural or genetic factors. For instance, in 1999, 72 percent of news reports, compared to 40 percent of the scientific articles, evoke individual contributors to weight. In 2003, 98 percent of the news sample, compared to 40 percent of the science sample, stress individual responsibility for weight. Among individual behaviors blamed for excess weight, the press is especially likely to focus on food choices and sedentary lifestyles. In 1999, 58 percent of the news reports, compared to 30 percent of the
JAMA
articles, evoke sociocultural contributors to obesity, including the food industry, the car culture, or urban planning.
However, in 2003, 30 percent of the
JAMA
articles, but only 12 percent of news reporting on those articles, mention sociocultural contributors. Only 10 percent of articles in the 1999
JAMA
issue and 10 percent of news reporting on that issue mention genetic contributors to obesity. In 2003, only 3 percent of the news mention genetic contributors to obesity, even though these are discussed by 20 percent of the corresponding science sample.

In many instances, the press use poetic license, drawing loosely on scientific articles to paint a picture of sloth and gluttony. “Americans are gobbling down more calories than ever, resulting in a 50 percent increase in the nation’s obesity rate,” begins the first line of one typical news report on the 1999 study of the “obesity epidemic.” 44 A different news article on the 1999 theme issue affirms, “Some 300,000 Americans die each year from eating millions of cookies, hot dogs, potato chips and other empty calories during increasingly inactive lives, according to another report also published in JAMA.” 45 That the scientific studies in question provided
no
data on the eating or exercise behaviors of their respondents did not prevent this or other journalists from speculating about individual excesses. It is as if there were an “incitement to discourse” about eating, just as there is for sex, so that “the more we talk about it, the more exciting and alluring it becomes both as an attraction and as a taboo.” 46

Figure 4.3:
Percentage of Scientific Studies or News Reports Evoking Specific Causes.

Just as the news media samples disproportionately cover studies with dramatic findings, so they focus more on studies that emphasize individual contributors to obesity. This tendency partly explains the greater discussion of personal responsibility in the news reports, compared to the scientific publications. Specifically, in 1999, more than one-third of the news reports (24 out of 69 articles) discuss an article entitled “Annual Deaths Attributable to Obesity in the United States”; these articles are, in turn, significantly more likely, than articles that do not discuss this study, to blame obesity on individual choices. Eighty-eight percent of press reports on this scientific study invoke individual contributors to weight, compared to 64 percent of articles that do not explicitly discuss this study. The authors of this study used a methodology originally formulated to calculate “tobacco deaths” and treated “obesity-attributable deaths” as avoidable and due to unhealthy individual choices.

Just as news media discussions of both the 1999 and 2003
JAMA
theme issues of obesity overwhelmingly focus on individual-level contributors to obesity, as opposed to sociocultural or genetic factors, so they are more likely to discuss individual-level solutions. Specifically, 80 percent of the 1999 news sample and 90 percent of the 2003 news sample discuss individual-level solutions, such as making changes to exercise or diet. (By contrast, only 35 percent of the 1999 news sample and 17 percent of the 2003 news sample discuss some sort of policy solution.) The news media samples are not more (or less) likely to discuss individual-level solutions than the scientific journal issues on which they were reporting, but they do sometimes exaggerate the efficacy of such solutions. For instance, the 2003
theme issue of
JAMA
features a meta-analysis and an editorial that explicitly addresses the efficacy and safety of low-carbohydrate diets and a research article on the efficacy of a commercial weight-loss program. It reports an average weight loss on Weight Watchers of less than 6.5 pounds after two years and finds inconclusive evidence for the efficacy of low-carbohydrate diets relative to higher-carbohydrate diets. Reporting on this study, a
Philadelphia Inquirer
article optimistically ensures readers “you can lose weight!” proclaiming in the first line: “The Atkins diet, Weight Watchers, even just getting off the couch can eliminate pounds. But there’s still no magic formula.” 47

HOW THE NEWS MEDIA REPORT ON SCIENTIFIC CONTROVERSY

None of the news reports on either the 1999 or 2003 theme issues of
JAMA
discussed debates about whether weight per se was a meaningful indicator of health or what is an appropriate cutoff point between healthy and unhealthy weight. While there was considerable debate over these topics at the time, they were not addressed in the 1999 or 2003 theme issues. Yet, there was discussion, in 1999, about the idea that one can be “fat and fit” because this was directly addressed in one of the articles in the
JAMA
theme published that year. This article showed that physical fitness—as measured by a treadmill test—is a better predictor of health and cardiovascular disease (CVD) than weight. 48 All six of the news articles reporting on this particular study (9 percent of the sample for that year) discussed the “fat and fit” or “health at every size” hypothesis, as in a
Philadelphia Inquirer
article quoting one of the senior coauthors, Steven Blair: “Blair is an advocate of fat-but-fit. His research, including an article in last week’s
JAMA
,
shows that being sedentary increases death risk, regardless of weight.” 49